COVID-19 morbidity and mortality associated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers use among 14,129 patients with hypertension from a US integrated healthcare system

Abstract

Objective Although recent evidence suggests no increased risk of severe COVID-19 outcomes associated with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) use, the relationship is less clear among patients with hypertension and diverse racial/ethnic groups. This study evaluates the risk of hospitalization and mortality among patients with hypertension and COVID-19 in a large US integrated healthcare system. Methods Patients with hypertension and COVID-19 (between March 1- September 1, 2020) on ACEIs or ARBs were compared with patients on other frequently used antihypertensive medications. Results Among 14,129 patients with hypertension and COVID-19 infection (mean age 60 years, 48% men, 58% Hispanic), 21% were admitted to the hospital within 30 days of COVID-19 infection. Of the hospitalized patients, 24% were admitted to intensive care units, 17% required mechanical ventilation, and 10% died within 30 days of COVID-19 infection. Exposure to ACEIs or ARBs prior to COVID-19 infection was not associated with an increased risk of hospitalization or all-cause mortality (rate ratios for ACEIs vs other antihypertensive medications = 0.98, 95% CI: 0.88, 1.08; ARBs vs others = 1.00, 95% CI: 0.90, 1.11) after applying inverse probability of treatment weights. These associations were consistent across racial/ethnic groups. Use of ACEIs or ARBs during hospitalization was associated with a lower risk of all-cause mortality (odds ratios for ACEIs or ARBs vs others = 0.50, 95% CI: 0.34, 0.72). Conclusion Our study findings support continuation of ACEI or ARB use for patients with hypertension during the COVID-19 pandemic and after COVID-19 infection.

Effect of common maintenance drugs on the risk and severity of COVID-19 in elderly patients

“…Recently published studies do have larger patient numbers. One such study supported by the American Heart Association's Rapid Response Grant COVID-19 is by An et al [50], with 4,652 patients on ACEI and 2,546 on ARB. However, this is still lower than the number of patients observed in our study, 97,843 on ACEI and 83,290 on ARB.…”

Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and COVID-19-related outcomes: A patient-level analysis of the PCORnet blood pressure control lab

“…Recent randomized controlled trials testing continuation vs. discontinuation of ACEI/ARB therapy have suggested no differential risk of infection or COVID-19 severity between these strategies [3] , [4] . Results from the observational studies have been much more variable, with some suggesting substantially lower mortality (~50–60% risk reductions) for ACEI/ARB users vs. non-users [5] , [6] , [7] , whereas others have suggested higher risk of mortality [8] . However, many of these studies have significant methodologic limitations [9] , and are limited by their homogenous populations, making interpretation and generalizability difficult.…”

The interacting physiology of COVID‐19 and the renin‐angiotensin‐aldosterone system: Key agents for treatment

“…Most studies that look at the impact of ACEIs in the treatment of hypertensive patients with COVID‐19 have not discriminated between ARBs and ACEIs but are associated with the significant reduction in all‐cause mortality (OR = 0.5, 95%, CI: 0.34, 0.72) 88 …”

“…However, ACEIs elevate concentrations of bradykinin, which have vasodilatory effects on cardiovascular tissues which could be beneficial in the morbidity associated with COVID-19. Studies have shown that treatment with ACEIs or ARBs is associated with a similar reduction in morbidity and mortality from COVID-19.Most studies that look at the impact of ACEIs in the treatment of hypertensive patients with COVID-19 have not discriminated between ARBs and ACEIs but are associated with the significant reduction in all-cause mortality (OR = 0.5, 95%, CI: 0.34, 0.72) 88. Hippisley-Cox 89 recently reported a study of over 8 000 000 people, of whom 19 486 had COVID-19 and 1286 received ICU care, 7.8% were treated with an ACEI and 3.7% with an ARB.…”